Multidrug resistance to antimicrobials as a predominant factor influencing patient survival
Introduction
The increased prevalence of multidrug-resistant (MDR) isolates in the nosocomial setting has raised the need for new strategies in the management of nosocomial infections [1]. One dominant question that the clinician often faces nowadays is whether infections by MDR pathogens significantly affect mortality. Few studies have been performed and they are characterised by controversy. Infections by resistant isolates of Staphylococcus aureus [2] and Enterococcus faecalis [3] are accompanied by lower survival rates compared with infections by susceptible isolates of the same species, and a recent meta-analysis of 31 studies concluded that bacteraemia by methicillin-resistant S. aureus (MRSA) led to decreased survival compared with methicillin-susceptible S. aureus (MSSA) [4]. However, a recent study failed to disclose any difference in mortality rates of critically ill patients with nosocomial bacteraemias caused by either antibiotic-resistant or -susceptible Gram-negative pathogens [5].
The controversial results of the above studies raise the need to identify the impact of multidrug resistance on the overall survival of hospitalised patients with severe infections. The present study was designed to clarify this issue.
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Study design
In a prospective study for the period January 1997 to January 2000, all patients hospitalised with either a community-acquired or a hospital infection at the 1st Department of Propedeutic Medicine of Laikon General Hospital of Athens were followed-up. Two hundred and forty-three patients with a definite microbiological diagnosis of infection matched for age and sex were considered for further statistical analysis. The study was approved by the Ethics Committee of the Laikon General Hospital of
Results
The demographic data for patients enrolled in the study are shown in Table 1. A total of 82 patients presented with infections by susceptible isolates and 161 with infections by MDR isolates. Mortality rates of infections caused by susceptible and MDR isolates in general were 4.87% and 16.15% (P = 0.013). Mortality rates in relation to the species of pathogen are given in Table 2.
Comparative survival curves of patients infected by susceptible or MDR pathogens are shown in Fig. 1. Mean (± standard
Discussion
The emerging problem of multidrug resistance in everyday nosocomial practice renders the question of whether resistant isolates are more or less virulent compared with susceptible isolates of the same species [14], [15]. The present study attempted to resolve that question in a cohort of 243 patients (Table 1). All enrolled subjects presented with a microbiologically defined infection by a variety of species of susceptible or MDR isolates. Statistical analysis attempted to exclude probable
References (22)
- et al.
Procalcitonin C-reactive protein and APACHE II score for risk evaluation in patients with severe pneumonia
Clin Microbiol Infect
(2002) - et al.
Intensive-care-unit-acquired bloodstream infections in a regional critically ill population
J Hosp Infect
(2004) - et al.
Potential use of procalcitonin as a diagnostic criterion in febrile neutropenia: experience from a multicentre study
Clin Microbiol Infect
(2004) - et al.
Comparison of the incidence of virulence determinants and antibiotic resistance between Enterococcus faecium strains of dairy, animal and clinical origin
Int J Food Microbiol
(2003) - et al.
Experimental sepsis using Pseudomonas aeruginosa: the significance of multidrug resistance
Int J Antimicrob Agents
(2004) - et al.
Multidrug-resistant Pseudomonas aeruginosa bloodstream infection: analysis of trends in prevalence and epidemiology
Emerg Infect Dis
(2002) - et al.
Is methicillin-resistant Staphylococcus aureus more virulent than methicillin-susceptible S. aureus? A comparative cohort study of British patients with nosocomial infection and bacteremia
Clin Infect Dis
(2003) - et al.
Association between the presence of enterococcal virulence factors gelatinase, hemolysin, and enterococcal surface protein and mortality among patients with bacteremia due to Enterococcus faecalis
Clin Infect Dis
(2002) - et al.
Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis
Clin Infect Dis
(2003) - et al.
Nosocomial bacteremia caused by antibiotic-resistant Gram-negative bacteria in critically ill patients: clinical outcome and length of hospitalization
Clin Infect Dis
(2002)
Antimicrobial-induced endotoxemia in patients with sepsis in the field of acute pyelonephritis
J Postgrad Med
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